Schmitz Michelle M, Serbanescu Florina, Arnott George E, Dynes Michelle, Chaote Paul, Msuya Abdulaziz Ally, Chen Yi No
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Kigoma Regional Medical Office, Kigoma, Tanzania, United Republic of.
BMJ Glob Health. 2019 Aug 17;4(Suppl 5):e001568. doi: 10.1136/bmjgh-2019-001568. eCollection 2019.
Timely, high-quality obstetric services are vital to reduce maternal and perinatal mortality. We spatially modelled referral pathways between sending and receiving health facilities in Kigoma Region, Tanzania, identifying communication and transportation delays to timely care and inefficient links within the referral system.
We linked sending and receiving facilities to form facility pairs, based on information from a 2016 Health Facility Assessment. We used an AccessMod cost-friction surface model, incorporating road classifications and speed limits, to estimate direct travel time between facilities in each pair. We adjusted for transportation and communications delays to create a total travel time, simulating the effects of documented barriers in this referral system.
More than half of the facility pairs (57.8%) did not refer patients to facilities with higher levels of emergency obstetric care. The median direct travel time was 25.9 min (range: 4.4-356.6), while the median total time was 106.7 min (22.9-371.6) at the moderate adjustment level. Total travel times for 30.7% of facility pairs exceeded 2 hours. All facility pairs required some adjustments for transportation and communication delays, with 94.0% of facility pairs' total times increasing.
Half of all referral pairs in Kigoma Region have travel time delays nearly exceeding 1 hour, and facility pairs referring to facilities providing higher levels of care also have large travel time delays. Combining cost-friction surface modelling estimates with documented transportation and communications barriers provides a more realistic assessment of the effects of inter-facility delays on referral networks, and can inform decision-making and potential solutions in referral systems within resource-constrained settings.
及时、高质量的产科服务对于降低孕产妇和围产期死亡率至关重要。我们对坦桑尼亚基戈马地区转诊医疗机构之间的转诊路径进行了空间建模，确定了及时就医过程中的沟通和交通延误以及转诊系统内的低效环节。
根据2016年医疗机构评估信息，将转诊和接收机构配对。我们使用了一个包含道路分类和限速的AccessMod成本摩擦表面模型，来估计每对机构之间的直接出行时间。我们对交通和通信延误进行了调整，以得出总出行时间，模拟该转诊系统中记录的障碍的影响。
超过一半的机构对（57.8%）没有将患者转诊到具备更高水平产科急诊护理的机构。直接出行时间中位数为25.9分钟（范围：4.4 - 356.6分钟），而在中等调整水平下，总时间中位数为106.7分钟（22.9 - 371.6分钟）。30.7%的机构对总出行时间超过2小时。所有机构对的交通和通信延误都需要进行一些调整，94.0%的机构对总时间增加。
基戈马地区所有转诊对中有一半的出行时间延误几乎超过1小时，转诊到提供更高护理水平机构的机构对也有较大的出行时间延误。将成本摩擦表面建模估计与记录的交通和通信障碍相结合，能更现实地评估机构间延误对转诊网络的影响，并可为资源有限环境下转诊系统的决策制定和潜在解决方案提供参考。
